To effectively address maternal mortality, severe maternal morbidity, and health equity, it is critical that the federal government, industry, and philanthropic foundations prioritize investment in and expansion of pregnancy and postpartum research, including clinical trials during pregnancy and the postpartum period. Improving health before, during, and after pregnancy has the potential to benefit pregnant people, neonates, and families through subsequent generations. The Society for Maternal‐Fetal Medicine (SMFM) urges: Federal policymakers to prioritize and provide dedicated resources for pregnancy research, including additional funding to study, disseminate, and implement interventions that optimize pregnancy outcomes. Industry and other private funders to increase support for pregnancy research and work collaboratively with stakeholders to optimize the health of individuals during and after pregnancy. Investigators and institutional review boards to presume, as recommended by the National Academy of Medicine, that pregnant and lactating individuals are eligible for participation in clinical studies. Federal agencies to require investigators to provide appropriate explanation and justification for excluding pregnant and postpartum individuals from their research. Federal agencies to require pregnancy‐focused studies. Federal and private programs to support training the next generation of maternal health researchers and physician‐scientists. Expanding access to research by including pregnant and postpartum individuals from diverse backgrounds and access points, including from urban and rural communities. These critical steps are required to provide an evidence base for practice that will advance meaningful change in obstetric practice and improve maternal and pregnancy‐related health outcomes.

The process of human parturition involves inflammation at the interface where fetal chorion trophoblast cells interact with maternal decidual stromal (DS) cells and maternal immune cells in the decidua (endometrium of pregnancy). This study tested the hypothesis that inflammation at the chorion–decidua interface (CDI) induces labor by negating the capacity for progesterone (P4) to block labor and that this is mediated by inactivation of P4 in DS cells by aldo-keto reductase family 1 member C1 (AKR1C1). In human, Rhesus macaque, and mouse CDI, AKR1C1 expression increased in association with term and preterm labor. In a human DS cell line and in explant cultures of term human fetal membranes containing the CDI, the prolabor inflammatory cytokine, interleukin-1ß (IL-1ß), and media conditioned by LPS-stimulated macrophages increased AKR1C1 expression and coordinately reduced nuclear P4 levels and P4 responsiveness. Loss of P4 responsiveness was overcome by inhibition of AKR1C1 activity, inhibition of AKR1C1 expression, and bypassing AKR1C1 activity with a P4 analog that is not metabolized by AKR1C1. Increased P4 activity in response to AKR1C1 inhibition was prevented by the P4 receptor antagonist RU486. Pharmacologic inhibition of AKR1C1 activity prevented parturition in a mouse model of inflammation-induced preterm parturition. The data suggest that inflammatory stimuli at the CDI drive labor by inducing AKR1C1-mediated P4 inactivation in DS cells and that inhibiting and/or bypassing of AKR1C1-mediated P4 inactivation is a plausible therapeutic strategy to mitigate the risk of inflammation-associated preterm birth.

When the Supreme Court of the United States decided Dobbs v. Jackson, it overruled Roe v. Wade and the decades of legal protections that physicians and patients have relied upon in making pregnancy decisions, including but not limited to abortion care. Abortion access has been limited before Dobbs, but the new legal landscape substantially limits patient access to abortion care by greatly curtailing legal provision of these services in many states, restricting physicians' ability to provide legal abortion care through confusing, inconsistent, and burdensome legal requirements, and by upending decades of reliable standards and leaving physicians and lawyers guessing about possible future court decision. Medical societies and healthcare organizations over the last 50 years since Roe have largely been silent in the face of attacks to abortion rights. Their silence left a void in which politicians and legislators without an understanding of abortion care promoted their own ideology and political interest at the expense of patient access to abortion care, patient autonomy, the physician-patient relationship, and physician autonomy. Physicians have an ethical duty to organize and advocate. Abortion legislation exemplifies the impact of unjust policies limiting our ability to provide patients with autonomy over their medical decision-making and interfering in the provision of evidence-based care, and in some cases preventing us from upholding our oath to do no harm. We must regain control of the examination room from political ideologies so that we can provide equitable, patient-centered, evidence-based, autonomous healthcare to our patients.

IMPORTANCE:Pregnancy induces unique physiologic changes to the immune response and hormonal changes leading to plausible differences in the risk of developing post-acute sequelae of SARS-CoV-2 (PASC), or Long COVID. Exposure to SARS-CoV-2 during pregnancy may also have long-term ramifications for exposed offspring, and it is critical to evaluate the health outcomes of exposed children. The National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC aims to evaluate the long-term sequelae of SARS-CoV-2 infection in various populations. RECOVER-Pregnancy was designed specifically to address long-term outcomes in maternal-child dyads. METHODS:RECOVER-Pregnancy cohort is a combined prospective and retrospective cohort that proposes to enroll 2,300 individuals with a pregnancy during the COVID-19 pandemic and their offspring exposed and unexposed in utero, including single and multiple gestations. Enrollment will occur both in person at 27 sites through the Eunice Kennedy Shriver National Institutes of Health Maternal-Fetal Medicine Units Network and remotely through national recruitment by the study team at the University of California San Francisco (UCSF). Adults with and without SARS-CoV-2 infection during pregnancy are eligible for enrollment in the pregnancy cohort and will follow the protocol for RECOVER-Adult including validated screening tools, laboratory analyses and symptom questionnaires followed by more in-depth phenotyping of PASC on a subset of the overall cohort. Offspring exposed and unexposed in utero to SARS-CoV-2 maternal infection will undergo screening tests for neurodevelopment and other health outcomes at 12, 18, 24, 36 and 48 months of age. Blood specimens will be collected at 24 months of age for SARS-CoV-2 antibody testing, storage and anticipated later analyses proposed by RECOVER and other investigators. DISCUSSION:RECOVER-Pregnancy will address whether having SARS-CoV-2 during pregnancy modifies the risk factors, prevalence, and phenotype of PASC. The pregnancy cohort will also establish whether there are increased risks of adverse long-term outcomes among children exposed in utero. CLINICAL TRIALS.GOV IDENTIFIER:Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011.

To determine whether delivery time of day is associated with differences in neonatal management or outcome in late preterm infants. Previous investigations of neonatal morbidity based on delivery time of day have focused on infants at term and early preterm gestational ages. This is a secondary analysis of ALPS, a multicenter trial of patients with anticipated late preterm delivery (34w0d-36w6d) randomized to betamethasone or placebo. Patients were assigned to a daytime (0700-1859) or nighttime cohort (1900-0659) using the documented time of birth. Study group characteristics were compared using chi-squared test for categorical data and Wilcoxon test for continuous data. Logistic regression models were used to adjust for birth weight, mode of delivery, and ALPS group assignment. The primary outcome was the administration of respiratory resuscitation in the first 30 minutes of life. Characteristics of the two cohorts are summarized in Table 1. There were 1539 daytime deliveries and 1288 nighttime deliveries. The daytime birth cohort had a significantly higher rate of Cesarean delivery and a higher mean birth weight. There was no significant difference in the primary outcome of administration of respiratory resuscitation in the first 30 minutes of life (aRR 1.03, 95% CI 0.86-1.24, p=0.73). Secondary outcomes, including administration of surfactant and NICU admission, were also comparable between the groups (Table 2). Of infants who received surfactant, the average duration of time to surfactant administration was not significantly different between daytime versus nighttime births. Previous studies have inconsistently demonstrated an association of delivery time of day with neonatal morbidity and mortality in early preterm and term infants. Here, we show that in late preterm infants, daytime compared to nighttime birth is not associated with increased neonatal morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

BACKGROUND: High-quality evidence to inform the management of postpartum hypertension, including the optimal blood pressure threshold to initiate therapy, is lacking. Randomized trials have been conducted in pregnancy, but there are no published trials to guide management in the postpartum period.OBJECTIVE: This study aimed to test the hypothesis that initiating anti-hypertensive therapy in the postpartum period at a threshold of 140/ 90 mm Hg would result in less maternal morbidity than initiating therapy at a threshold of 150/95 mm Hg.STUDY DESIGN: We performed a pragmatic multicenter randomized controlled trial of patients aged 18 to 55 years with postpartum hyperten-sion. Patients with chronic hypertension, gestational hypertension, and preeclampsia without severe features were randomized to 1 of 2 blood pressure thresholds to initiate treatment: persistent blood pressure of >= 150/95 mm Hg (institutional standard or "liberal control" group) or >= 140/90 mm Hg (intervention or "tight control" group). Our primary out-come was composite maternal morbidity defined as: severe hypertension (blood pressure >= 160/110 mm Hg) or preeclampsia with severe features, the need for a second antihypertensive agent, postpartum hospitalization >4 days, and maternal adverse outcome secondary to hypertension as evidenced by pulmonary edema, acute kidney injury (creatinine level >= 1.1 mg/dL), cardiac dysfunction (eg, elevated brain natriuretic peptide level) or cardiomyopathy, posterior reversible encephalopathy syndrome, cerebro-vascular accident, or admission to an intensive care unit. Secondary out- comes included hospital readmission for hypertension, persistence of hypertension beyond 14 days, medication side effects, and time to blood pressure control. We calculated that 256 women would provide 90% power to detect a relative 50% reduction in the primary outcome from 36% in the standard blood pressure threshold group to 18%, with a 2-sided alpha set at 0.05 for significance. Data were analyzed using R sta-tistical software.RESULTS: A total of 256 patients were randomized, including 128 to the "tight control" group (140/90 mm Hg) and 128 to the "liberal control" group (150/95 mm Hg). Patients in the "tight control" group had a higher body mass index at delivery (37.1+9.4 vs 34.9+8.1; P=.04); other demographic and obstetrical characteristics were similar between groups. The rate of the primary outcome was similar between groups (8.6% vs 11.7%; P=.41; relative risk, 0.73; 95% confidence interval, 0.35-1.53). The rates of all secondary outcomes and the individual components of the primary and secondary outcome measures were also similar between groups.CONCLUSION: In the postpartum period, initiation of antihypertensive therapy at a lower blood pressure threshold of 140/90 mm Hg did not decrease maternal morbidity or improve outcomes compared with a threshold of 150/95 mm Hg.

Objective We evaluated whether there is an association between beta-globin (HBB) pathogenic variants and fetal fraction (FF), and whether the association has a clinically relevant impact on non-invasive prenatal screening (NIPS). Method A whole-genome sequencing NIPS laboratory database was retrospectively queried for women who underwent NIPS and carrier screening of both HBB and the alpha-globin genes (HBA1/HBA2). Women affected with either condition were excluded from the study, yielding a cohort size of 15,853. A "corrected FF" was obtained via multivariable linear regression adjusted for the systematic impacts of maternal age, gestational age and BMI. Corrected FF distributions of HBB and HBA1/HBA2 carriers were each compared to non-carriers using the Kolmogorov-Smirnov test. Results In this cohort, 291 women were carriers for HBB alone, and 1016 were carriers for HBA1/HBA2 alone. The HBB carriers had a lower corrected FF when compared to non-carriers (p < 0.0001). There was no difference in corrected FF among carriers and non-carriers of HBA1/HBA2. Conclusion Carriers of pathogenic variants in the HBB gene, but not the HBA1/HBA2 genes, are more likely to have lower FF when compared to women with structurally normal hemoglobin. This decrease in FF could result in an elevated test-failure rate if FF thresholds were used.

Our study explores the temporal association between low birth weight (LBW) infants and the increasing population prevalence of interracial relationships. Our hypothesis was that the odds of LBW would decrease as the population prevalence of interracial relationships increased. National Center for Health Statistics Natality data for 1971–2016 was analyzed. LBW was defined as birth weight less than 2500 gm. We restricted our analyses to singleton births by White and Black mothers with reported White or Black partners of the neonate. Logistic regression was used to calculate the odds ratios of LBW, both unadjusted and adjusted for maternal education and parental ages. The proportion of couples coded as interracial increased annually from 0.36

Parturition is associated with histologic inflammation, a pathway through which chorioamnionitis (CA) is thought to act. Progesterone receptor (PR) changes play a role in inducing this process. We evaluated the relationship between CA grade and extent of both myometrial leukocyte infiltration and PR modification to pSer345-PRA, which inhibits the usual anti-inflammatory activity maintained between isoforms PRA and PRB. To create a model of CA grade, pregnant Rhesus macaques were treated with intra-amniotic live E. Coli (106 CFU), E. Coli derived lipopolysaccharide (O55:B5, 1mg) or saline control. Animals were delivered by c-section 48h later and uterine tissue was collected. The membranes were blindly assigned a CA grade based on leukocyte density. The samples were then evaluated by CA grade as None (0), Low Grade (1-2) and High Grade (3-4). Immunohistochemistry (IHC) was performed to compare: 1) Myometrial leukocyte infiltration via CD45+ cell count; 2) The proportion of modified PRA to total PR via ImageJ analysis of DAB staining in paired images. One-way ANOVA and post-hoc Tukey testing was used. Tissue from 17 macaques was assessed. IHC results evaluated by CA grade demonstrated: 1) A rise in myometrial leukocyte count with CA severity that was significant between groups (p = 0.002), with mean counts and Tukey p-values in Figure 1A. Visualized on IHC (Figure 2A-B), with increasing inflammatory stimulus immune cells migrated from the perivascular space to the myometrial bundles; 2) An increased prevalence of modified PRA to total PR with CA grade was significant in the decidua (p < 0.001; Figure 2C-F) but not in the myometrium, with mean ratios and Tukey p-values in Figure 1B. In our model, CA grade correlates with inflammation in both the membranes and myometrium as evidenced by leukocyte magnitude. Altering PR function, particularly in the decidua, may play a role in propagating this pro-inflammatory cascade. Further studies on the association of inflammation and PR modification are needed to better understand this process and its relation to labor.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Whole exome sequencing (WES) has recently been shown to be useful in determining genetic causes of stillbirth, further adding complexity to currently available technologies. We aim to perform cost-effectiveness analysis of algorithms in genetic testing for stillbirth. Literature review was performed to obtain data regarding the performance of karyotype, chromosomal microarray (CMA) and WES on stillbirth. We created 10 approaches for various testing algorithms using karyotype, CMA and WES. Reflex testing is defined as testing if the previous result was negative OR failed to yield results. Point simulations using these 12 different algorithms were done to calculate expected annual total diagnosis, hit-rate, cost/diagnosis and missed diagnosis assuming national birth rate of 3,788,235 births/year and stillbirth rate of 0.6% (Table 1). We then selected four algorithms with the highest hit-rate without WES and the two algorithms with WES and performed Monte Carlo simulations by letting the parameters vary to provide cost/diagnosis ranges estimate for each selected algorithm. One-way ANOVA was used to compare cost/diagnosis for each algorithm. The results of the point simulations were shown in Table 1. Figure 1 shows the result of Monte Carlo simulation of cost/diagnosis for the 6 selected algorithms. Universal karyotype with reflex CMA for culture failure only and universal CMA only have the lowest median cost/diagnosis at $7,122.61 and $9,863.61, respectively. Despite being used frequently, reflex CMA with culture failure OR normal karyotype does not appear to be cost-effective. At present, the cost of WES is likely still prohibitive for its widespread usage in stillbirth. The option of which algorithm to use could vary from one place and another depending on the willingness to pay and desired hit rate. To aid health systems and policy makers, we have created a calculator to show the calculation result using different birth rate and cost of testing. http://bit.ly/StillBirthCalc (download and click to open the file to access the calculator).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The use of cervical cerclage in twin gestation is controversial, and little is known about practice variance. Our objective was to assess the rate of cerclage placement in twin gestation and variation by region and hospital characteristics. A retrospective cohort study was performed using The National Inpatient Sample from 2012 – 2016 comparing hospitalizations for cerclage placement in twin versus singleton gestations. Women 10-55 years of age with delivery-related hospitalizations or cerclage placement were included. High order multiples, ectopic, molar pregnancies and terminations were excluded. International Classification of Disease 9th and 10th edition diagnosis and procedure codes were used to identify our cohort and outcomes. The primary outcome was rate of cerclage placement in twin pregnancies. Secondary outcomes included maternal morbidity relative to cerclage placement in singleton gestation, and hospital size, location, and region, assessed by comparing twin gestations admitted for cerclage placement to overall twin delivery admissions. 4,229 admissions for cerclage placement met inclusion criteria, 438 (9.4%) were twins. The rate of cerclage placement was 0.13% in singleton versus 1.3% in twin gestations. Patients with twins had a longer length of stay (p < 0.001), and increased risk of premature rupture of membranes (p < 0.001); chorioamnionitis (p = 0.002); preterm (p < 0.001) and cesarean delivery (p < 0.001) during the same hospitalization. There were significant differences in cerclage placement by geographic region (p < 0.001), and hospital size (p < 0.001) and location (p < 0.001) also observed. The rate of cerclage placement in twin gestation in a large, national cohort is 1.3%. Relative to singleton gestation, placement of cerclage in twin gestations was associated with increased maternal morbidity. Cerclage placement for twins was more common in the South and in large academic medical centers.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Perinatal depression and anxiety are common, and have been associated with increased length of stay (LOS) and hospital costs in patients with other comorbid conditions. Our objective is to assess LOS and hospital costs in women with depression and anxiety admitted for hyperemesis gravidarum (HEG). We performed a retrospective cohort study using the National Inpatient Sample comparing hospitalizations for HEG or nausea and vomiting of pregnancy (NVP) of women age 12-55 with and without a history of depression, anxiety, or bipolar depression in 2012-2016. Ectopic and molar pregnancies, spontaneous abortions, and terminations were excluded. International Classification of Disease 9th and 10th edition diagnosis and procedure codes were used to identify our cohort and outcomes. The primary outcomes were maternal LOS and total cost of hospitalization. Secondary outcomes included maternal comorbidities and hospital characteristics. Univariate analyses were performed for all primary and secondary outcomes, and multivariate regression was performed for LOS and total cost of hospitalization, controlling for confounding variables. 42,745 hospitalizations for HEG or NVP were identified, 6,850 (16%) of whom had documented depression, anxiety, or bipolar depression. Women with depression or anxiety had a significantly longer LOS (p < 0.001) and significantly higher total hospitalization cost (p < 0.001) compared to women without such history. In multivariate regression, depression or anxiety was associated with an increased risk of LOS > 3 days (aOR 1.50 / 95% CI 1.37 – 1.64) and total hospital cost > $4,000 (aOR 1.56 / 95% CI 1.42 – 1.71). After controlling for pre-existing conditions and hospital characteristics, a diagnosis of depression, anxiety, or bipolar depression was associated with statistically significantly increased length of hospital stay and greater total hospital costs in women admitted for HEG or NVP, though these differences are small and may not be clinically significant.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The impact of von Willebrand disease (VWD) on pregnancy has been narrowly characterized beyond an association with increased hemorrhage risk and need for transfusion. We sought to evaluate the relationship between VWD and severe maternal morbidity (SMM) at time of delivery. Using National Inpatient Sample data from 2007-2013, we identified delivery admissions for women with and without a diagnosis of VWD (ICD-9-CM 286.4). We examined the rates of SMM as defined by the Centers for Disease Control and Prevention for these two groups, both including then excluding blood product transfusion. Poisson regression evaluated the association between VWD and SMM controlling for maternal comorbidities using a validated index (low: 0, moderate: 1-2, high: >2) and mode of delivery. Data analysis was weighted to provide national estimates. We identified 5.7 million delivery admissions during this study period, of which 2,357 (0.04%) carried a diagnosis of VWD. The rate of SMM was significantly higher in women with VWD compared to women without VWD (6.6% vs 1.5%), and this persisted after excluding transfusion (1.31% vs 0.6%, both p<0.001). The incidence rate ratio after adjusting for maternal comorbidities and mode of delivery for overall SMM was 4.08 (95% CI 3.80-4.38) and with transfusion excluded was 1.97 (95% CI 1.68-2.31, both p<0.001). Several individual SMM indicators were associated with VWD including anesthesia complications, transfusion, air and thrombotic embolism, disseminated intravascular coagulation, acute respiratory distress syndrome and hysterectomy (Figure 1). Women with VWD experience four-fold the incidence of SMM at delivery compared with unaffected women. Even with blood product transfusion excluded, VWD doubles the incidence rate of SMM. Our study likely underestimates the complete impact of VWD on maternal morbidity as we focused only on the delivery admission. Further studies on the association of VWD with non-transfusion related SMM are needed to better inform delivery planning and postpartum care for women with VWD.

Perinatal depression is common, and the rate of depression diagnosis recorded at delivery has been increasing. Depression has been associated with increased length of stay (LOS) and hospital costs in patients with other comorbid conditions. Our objective is to assess delivery LOS and hospital costs in women with depression. We performed a retrospective cohort study using the National Inpatient Sample comparing delivery hospitalizations of women with and without a history of depression in 2012-2016. Ectopic pregnancies, spontaneous and elective abortions were excluded. International Classification of Disease 9th and 10th edition diagnosis and procedure codes were used to identify our cohort and outcomes. The primary outcomes were maternal LOS and total cost of delivery hospitalization. Secondary outcomes included maternal comorbidities, delivery morbidities, and hospital characteristics. Univariate analyses were performed for all primary and secondary outcomes, and multivariate regression was performed for LOS, non-home discharge, and total cost of delivery hospitalization, controlling for confounding variables. 3,531,288 admissions met inclusion criteria, 50,865 (1.4%) of whom had documented depression. There was no significant difference in LOS in women with depression (p=0.16). Women with depression had a higher total hospital cost ($4,194 (2,986-6,042) vs $3,810 (2,731 – 5,413), p<0.001), and were more likely to have a non-home discharge (p<0.001) compared to women without depression. In multivariate regression, depression was associated with increased risk of LOS >3 days (aOR 1.04/95% CI 1.04-1.04), non-home discharge (aOR 1.78/95% CI 1.69-1.88), and total hospital cost >$4,000 (aOR 1.04/95% CI 1.03-1.05). After controlling for pre-existing conditions, mode of delivery, and hospital characteristics, depression was associated with statistically significantly increased length of hospital stay, non-home discharge, and greater total hospital costs, though these differences were small and not likely clinically significant.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Women coded as being in interracial relationships have altered odds of low birthweight (LBW). This is likely secondary to societal stressors rather than a biologic basis. Thus, the association should vary over time with sociocultural changes as the proportion of couples coded as interracial has increased. Our aim was to evaluate the association between the odds of LBW in couples coded as interracial and their population incidence over time. Our hypothesis was that the odds of LBW would decrease as the population incidence increased. National Center for Health Statistics Natality data for 1971-2016 was analyzed. LBW was defined as less than 2500 grams. We restricted our analyses to singleton births by White and Black mothers with reported White or Black fathers of the neonate. Logistic regression was used to calculate the odds ratios (OR) of LBW adjusted for maternal education and parental ages and unadjusted. The association between the OR of LWB within a given year and that year’s prevalence of interracial couples was evaluated via meta-regression with random effects. The proportion of couples coded as interracial increased annually from 0.36% in 1971 to 3.86% for White mothers and 0.59% to 8.63% for Black mothers. In each year the OR of LBW was significant. Figures 1 and 2 show each individual year’s OR with a circle proportional to the standard error as well as the metaregression trend line. As the proportion of White mothers with Black partners increased, their OR of LBW declined (1.75 to 1.30, p<0.001). The OR of LBW among Black mothers with White partners, however, did not change (p=0.22). As the annual proportion of White mothers with Black partners increased, their odds of LBW decreased, though was always lower than Black mothers. Black mothers with White partners did not exhibit a similar change. Though causation cannot be established, changes in the proportion of interracial couples over decades is associated with decreasing odds of LBW amongst White women but not Black women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

To investigate the impact of antenatal mood disorders on breastfeeding. We conducted a prospective cohort study of women with and without pre-existing mood disorders. Consecutive women > 18 years of age, 16-36 weeks gestation without contraindications to breastfeeding were eligible for enrollment. Data was obtained through medical records and patient surveys. Participants completed Adverse Childhood Experience (ACE) on intake; and Edinburgh Postnatal Depression (EPDS) and Generalized Anxiety Disorder (GAD7) scales, and breastfeeding surveys during prenatal care, postpartum (PP) admission, and at 3 and 6 months PP. The primary outcome was any breastfeeding at 3 months PP. Secondary outcomes included breastfeeding intention, initiation, duration, and exclusivity; EPDS, GAD7, and ACE scores. Primary and secondary outcomes were assessed with univariable analyses. Planned subgroup analyses were performed by intake EPDS and GAD7 scores. A total of 299 patients were enrolled, of whom 123 (41%) had mood disorders. There were no significant differences in breastfeeding at 3 months PP (26 vs 31%, p = 0.37), nor in intention, initiation, duration or exclusivity in women with mood disorders versus those without. Those with mood disorders had significantly higher intake ACE, EPDS, and GAD7 scores. In subgroup analyses, women with EPDS > 12 (16% vs 34%, p = 0.003) and women with GAD7 > 10 (19% vs 33%, p = 0.03) were significantly less likely to breastfeed at 3 months. Antenatal mood disorders were not associated with significant differences in breastfeeding outcomes, however women with high intake EPDS or GAD7 scores were less likely to breastfeed at 3 months. This suggests that having a historical diagnosis of depression or anxiety will not necessarily affect breastfeeding, though experiencing depression or anxiety symptoms in pregnancy significantly impacts breastfeeding outcomes. Thus, universal screening for mood disorders both in pregnancy and postpartum may be beneficial to identify patients at risk and provide additional support.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The association of low fetal-fraction (FF) in women affected by beta-chain hemoglobinopathies has previously been described. It is not clear if this holds true for unaffected beta-chain hemoglobinopathy carriers. We evaluated whether there is an association between β-globin (HBB) pathogenic variants and FF, and whether it has a clinically relevant impact on non-invasive prenatal screening (NIPS). A whole-genome sequencing NIPS laboratory database was retrospectively queried for all women with NIPS and carrier screening of the HBB gene; NIPS patients tested for α-globin (HBA1/HBA2) gene(s) were used as biological comparators. Affected women were excluded from the study, and all subjects included in the analysis had consented to deidentified research. Mutation status for both genes was classified as non-carrier or carrier. Multivariable linear regression removed the systematic impacts of maternal age, gestational age and BMI to yield a "corrected FF" for each patient. Corrected FF distributions were compared between the two mutation-status classes using the Kolmogorov-Smirnov test, and expected test-failure rates were calculated as a function of FF threshold. A total of 19,929 women had both NIPS and carrier screening involving the HBB gene, with 19,686 and 243 being non-carrier and carrier, respectively. The HBB carrier groups have lower corrected FF when compared to non-carrier (p < 0.0001; Fig. 1A). By comparison, 15,854 and 1,017 women were found to be non-carrier and carrier of HBA1/HBA2 pathogenic variants, respectively (N=16,871 patients), yet FF values did not differ among mutation carrier groups (p > 0.05; Fig. 1B). Expected test-failure rate for a fixed FF was higher in the HBB groups (Fig. 1 insets). Carriers of pathogenic variants in the HBB gene, but not the HBA1/HBA2 genes, are more likely to have lower FF when compared to women with structurally normal hemoglobin. This decrease in FF could result in an elevated test-failure rate if a fixed FF threshold were to be used.

oral health screening questions, 60% recommend that women undergo routine dental cleaning, and 65% reported counseling patients on the importance of oral health in pregnancy. Seventeen percent (17%) reported insufficient clinic time and 17% of Fellows reported lack of accepting dentists as reasons for not discussing oral health during prenatal care. However, 55% of Fellows reported patients would easily find an accepting dentist.

INTRODUCTION: Adnexal masses are common in pregnancy. Our objective is to evaluate outcomes of oophorectomy in pregnant women. METHODS: This is a retrospective cohort study using data from the National Inpatient Sample between 2007 and 2013. Reproductive-aged women undergoing oophorectomy were identified using International Classification of Diseases – 9 diagnosis and procedure codes. Ectopic pregnancies were excluded. The risk of ovarian cancer was compared between pregnant and non-pregnant women undergoing oophorectomy. Secondary outcomes included surgical and pregnancy complications. Univariable analyses and multivariable regression were performed with adjustment for confounding factors. RESULTS: 203,075 women aged 15–45 years undergoing oophorectomy were identified, of whom 17,285 (8.5%) were pregnant. Pregnancy was associated with a lower frequency of ovarian cancer diagnosis (0.9% vs 2.5%, P<.001, OR 0.4, 95% CI 0.3 – 0.4). This relationship persisted with multivariable regression (P<.001, aOR 0.3, 95% CI 0.3 – 0.4). Pregnant women were significantly less likely to undergo a laparoscopic procedure or to undergo hysterectomy, omentectomy, or lymph node dissection compared with non-pregnant women. Pregnant women were also significantly more likely to die during hospitalization; this relationship persisted in multivariable regression (0.16% vs 0.05%, P<.001, aOR 4.1, 95% CI 2.5 – 6.6). There were no significant differences in frequency of transfusion or venous thromboembolism. Of pregnant women, 82% delivered during hospitalization for oophorectomy, 78% of these delivered by cesarean. CONCLUSION: Oophorectomy in pregnancy is associated with a lower frequency of ovarian cancer diagnosis, though is associated with higher frequency of laparotomy and death during hospitalization.